Lung cancer or bronchogenic carcinoma refers to tumors originating in the lung parenchyma or within the bronchi (Munakomi, 2022). Lung cancers are generally divided into two main categories: small-cell lung cancer (SCLC) and non-small-cell lung cancer (NSCLC). NSCLC accounts for approximately 85% of all lung cancers. It is further divided into adenocarcinoma, squamous cell carcinoma, (SCC), and large cell carcinoma. SCLC is considered distinct from other lung cancers because of its clinical and biological characteristics (Tan & Karim, 2021).
Adenocarcinoma is the most common NSCLC cancer in the United States. It arises from the bronchial mucosal glands, a subtype observed most commonly in persons who do not smoke. Squamous cell carcinoma accounts for 25 to 30% of all lung cancers. SCC is found in the central parts of the lung. It is the type most often associated with hypercalcemia. Large cell carcinoma typically manifests as a large peripheral mass on the chest radiograph. This type accounts for 10 to 15% of lung cancers (Tan & Karim, 2022).
Smoking is the most common cause of lung cancer. It is estimated 90% of lung cancer cases are attributable to smoking. It is interesting to note that lung cancer was a relatively rare disease at the beginning of the 20th century. Its dramatic rise in later decades is mainly attributable to the increase in smoking among males and females (Munakomi, 2022).
No specific signs and symptoms exist for lung cancer. Lung cancer symptoms occur due to local effects of the tumor, such as cough due to bronchial compression by the tumor due to distant metastasis, stroke-like symptoms secondary to brain metastasis, paraneoplastic syndrome, and kidney stones due to persistent hypercalcemia (Munakomi, 2022).
Lung cancer is the most commonly diagnosed cancer worldwide and is the leading cause of cancer-related deaths. According to the Global Cancer Statistics report from 2020, lung cancer remained the leading cause of cancer death worldwide, with an estimated 1.8 million deaths (Munakomi, 2022).
Nursing Care Plans
Nursing care for clients diagnosed with lung cancer revolves around comprehensive supportive care. Client teaching can minimize complications and speed recovery from surgery, radiation, and/or chemotherapy.
Here are seven (7) lung cancer nursing care plans (NCP) and nursing diagnoses:
- Impaired Gas Exchange
- Ineffective Airway Clearance
- Acute Pain
- Deficient Knowledge
- Imbalanced Nutrition: Less Than Body Requirements
- Other Nursing Diagnoses
Impaired Gas Exchange
Centrally located obstructing tumors can cause the collapse of the entire lung with an absence of breath sounds on the side of the lesion. Rapid tumor growth may lead to obstruction of major airways, with distal collapse leading to post-obstructive pneumonia, infection, and fever (Tan & Karim, 2021).
- Impaired Gas Exchange
May be related to
- Removal of lung tissue
- Altered oxygen supply (hypoventilation)
- Decreased oxygen-carrying capacity of blood (blood loss)
Possibly evidenced by
- Restlessness/changes in mentation
- Hypoxemia and hypercapnia
- The client will demonstrate improved ventilation and adequate oxygenation of tissues by ABGs within the normal range.
- The client will be free of symptoms of respiratory distress.
Nursing Assessment and Rationales
1. Note respiratory rate, depth, and ease of respiration. Note the use of accessory muscles and pursed-lip breathing.
Respirations may be increased as a result of pain or as an initial compensatory mechanism to accommodate for the loss of lung tissue. Additionally, respiratory insufficiency is signaled by dyspnea and increased work of breathing, retractions, orthopnea, and cyanosis. In SCLC, clients usually experience shortness of breath; physical examination may reveal the use of the accessory muscles of respiration and nasal flaring (Tan & Karim, 2021).
2. Observe changes in skin or mucous membrane color, pallor, cyanosis, and edema.
Increased work of breathing and cyanosis may indicate increasing oxygen consumption, energy expenditures, and reduced respiratory reserve. Examination of the extremities may reveal clubbing, cyanosis, or edema. In the presence of superior vena cava (SVC) obstruction, the right upper extremity is usually edematous (Tan & Karim, 2021).
3. Auscultate lungs for air movement and abnormal breath sounds.
Consolidation and lack of air movement on the operative side are normal in the pneumonectomy client; however, the lobectomy client should demonstrate normal airflow in the remaining lobes. In clients diagnosed with NSCLC, upper airway obstruction is manifested by stridor and wheezing. Lower airway obstruction is manifested by asymmetric breath sounds, pleural effusion, pneumothorax, infiltrates, and post-obstructive processes (Tan & Karim, 2022).
4. Investigate restlessness and changes in mentation or level of consciousness.
A neurologic examination should be performed to assess for focal neurological deficits caused by brain metastases and for signs of spinal cord compression (Tan & Karim, 2022). This may also indicate increased hypoxia or complications such as a mediastinal shift in the pneumonectomy client when accompanied by tachypnea, tachycardia, and tracheal deviation.
5. Assess the client’s response to the activity.
Increased oxygen consumption demand and stress of surgery can result in increased dyspnea and changes in vital signs with activity; however, early mobilization is desired to help prevent pulmonary complications and to obtain and maintain respiratory and circulatory efficiency.
6. Note the development of fever.
Fever within the first 24 hours after surgery is frequently due to atelectasis. Temperature elevation within the 5th to 10th postoperative day usually indicates a wound or systemic infection.
7. Assess for cough and mucus production, hemoptysis, and chest pain.
Cough is present in 50 to 75% of clients diagnosed with lung cancer. Cough productive of large volumes of thin, mucoid secretions is seen in mucinous adenocarcinoma. In some cases, especially those with exophytic bronchial masses, a cough may signify secondary post-obstructive pneumonia. Hemoptysis is present in 15 to 30% of clients with lung cancer. Chest pain is present in approximately 20 to 40% of clients (Munakomi, 2022).
8. Monitor and graph ABGs, and pulse oximetry readings. Note hemoglobin (Hb) levels.
Decreasing Pao2 or increasing Paco2 may indicate the need for ventilatory support. Significant blood loss can result in decreased oxygen-carrying capacity, reducing Pao2. Arterial blood gas (ABG) levels are useful in the detection of respiratory failure in sick clients. Obtain ABG levels in clients with active systemic diseases or abnormal labored breathing (Tan & Karim, 2022).
9. Monitor chest radiography results and other imaging tests as indicated.
A chest radiograph is usually the first test ordered in clients in whom a lung malignancy is suggested. Clues from the chest radiograph may suggest the diagnosis of lung cancer, but may not be helpful in identifying a histologic subtype. A chest CT scan is a standard for lung cancer staging. The findings of CT scans of the chest and clinical presentation usually allow a presumptive differentiation between NSCLC and SCLC (Tan & Karim, 2022).
Nursing Interventions and Rationales
1. Encourage rest periods and limit activities according to client tolerance.
Adequate rest balanced with activity can prevent respiratory compromise. The client’s activity level, as measured by a performance status scale is an important prognostic factor. The client should be encouraged to remain active during and after treatment for lung cancer (Tan & Karim, 2022).
2. Educate regarding smoking cessation.
Advise clients that smoking cessation is the most important measure for preventing lung cancer; it may also improve prognosis in clients with early-stage lung cancer. Smoking cessation by others who share the client’s home, car, or both is also important. According to published data, the use of nicotine alternatives instead of cigarettes reduces the incidence of lung cancer, although it does not affect the incidence of ischemic heart disease (Tan & Karim, 2022).
3. Maintain patent airway by positioning, suctioning, and use of airway adjuncts.
Airway obstruction impedes ventilation, impairing gas exchange. In the case of upper airway obstruction, the client is admitted to the ICU, and prepared for intubation and/or cricothyrotomy and intraoperative tracheostomy (Tan & Karim, 2022).
4. Reposition frequently, placing the client in sitting positions and supine to side positions. However, avoid positioning the client with a pneumonectomy on the operative side; instead, favor the “good lung down” position.
This maximizes lung expansion and drainage of secretions. Research shows that positioning clients following lung surgery with their “good lung down” maximizes oxygenation by using gravity to enhance blood flow to the healthy lung, thus creating the best possible match between ventilation and perfusion (Lan et al., 2011).
5. Encourage and assist with deep-breathing exercises and pursed-lip breathing as appropriate.
This promotes maximal ventilation and oxygenation and reduces or prevents atelectasis. Breathing exercises aim to correct breathing errors, reestablish proper breathing patterns, increase diaphragm activity, elevate the amount of alveolar ventilation, reduce energy consumption when breathing, and relieve the shortness of breath experienced by clients diagnosed with lung cancer (Liu et al., 2013).
6. Maintain patency of the chest drainage system for lobectomy, segmental, or wedge resection.
These drain fluid from the pleural cavity to promote the re-expansion of remaining lung segments. The balanced chest drainage system was found to be associated with reduced rates of post-pneumonectomy pulmonary edema, which is a common cause of death after pneumonectomy (Wei Lo et al., 2020).
7. Note changes in the amount or type of chest tube drainage.
Bloody drainage should decrease in amount and change to a more serous composition as recovery progresses. A sudden increase in the amount of bloody drainage or return to frank bleeding suggests thoracic bleeding or hemothorax; sudden cessation suggests blockage of the tube, requiring further evaluation and intervention.
8. Observe the presence or degree of bubbling in the water-seal chamber.
Air leaks immediately postoperative are not uncommon, especially following lobectomy or segmental resection; however, this should diminish as healing progresses. Most intrathoracic air leaks will usually seal spontaneously, and resolution can be tracked by witnessing decreased bubbling in the device over days. Prolonged or new leaks require evaluation to identify problems in clients versus the drainage system (Merkle & Cindass, 2022).
9. Administer supplemental oxygen via nasal cannula, partial rebreathing mask, or high-humidity face mask, as indicated.
This maximizes available oxygen, especially while ventilation is reduced because of anesthetic, depression, or pain, and during the period of the compensatory physiological shift of circulation to remaining functional alveolar units. If hemoptysis is noted, administer supplemental oxygen and perform suctioning. If a threat of imminent demise exists, consider placing a double-lumen endotracheal tube (Tan & Karim, 2022).
10. Assist with and encourage the use of incentive spirometer.
This prevents or reduces atelectasis and promotes the re-expansion of small airways. Lung expansion therapy allows the client to maintain an effective cough mechanism to facilitate the removal of secretions from the airways following surgery. An incentive spirometer is a medical device, which helps the client sustain maximal inspiration under visual quantitation by inspiratory effort (Liu et al., 2019).
Recommended nursing diagnosis and nursing care plan books and resources.
NANDA International Nursing Diagnoses: Definitions & Classification, 2021-2023
The definitive guide to nursing diagnoses as reviewed and approved by the NANDA International. In this new version of a pioneering text, all introductory chapters have been rewritten to provide nurses with the essential information they need to comprehend assessment, its relationship to diagnosis and clinical reasoning, and the purpose and application of taxonomic organization at the bedside. A total of 46 new nursing diagnoses and 67 amended nursing diagnostics are presented.
Ackley and Ladwig’s Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care
We love this book because of it’s evidence-based approach to nursing interventions. This care plan handbook uses an easy, three-step system to guide you through client assessment, nursing diagnosis, and care planning. Includes step-by-step instructions show how to implement care and evaluate outcomes, and help you build skills in diagnostic reasoning and critical thinking.
Nursing Care Plans – Nursing Diagnosis & Intervention (10th Edition)
Includes over two hundred care plans that reflect the most recent evidence-based guidelines. New to this edition are ICNP diagnoses, care plans on LGBTQ health issues and on electrolytes and acid-base balance.
Nurse’s Pocket Guide: Diagnoses, Prioritized Interventions, and Rationales
Quick-reference tool includes all you need to identify the correct diagnoses for efficient patient care planning. The sixteenth edition includes the most recent nursing diagnoses and interventions from NANDA-I 2021-2023 and an alphabetized listing of nursing diagnoses covering more than 400 disorders.
Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care
Identify interventions to plan, individualize, and document care for more than 800 diseases and disorders. Only in the Nursing Diagnosis Manual will you find for each diagnosis…. subjectively and objectively – sample clinical applications, prioritized action/interventions with rationales – a documentation section, and much more!
All-in-One Nursing Care Planning Resource – E-Book: Medical-Surgical, Pediatric, Maternity, and Psychiatric-Mental Health
Includes over 100 care plans for medical-surgical, maternity/OB, pediatrics, and psychiatric and mental health. Interprofessional “patient problems” focus familiarizes you with how to speak to patients.
Other recommended site resources for this nursing care plan:
- Nursing Care Plans (NCP): Ultimate Guide and Database MUST READ!
Over 150+ nursing care plans for different diseases and conditions. Includes our easy-to-follow guide on how to create nursing care plans from scratch.
- Nursing Diagnosis Guide and List: All You Need to Know to Master Diagnosing
Our comprehensive guide on how to create and write diagnostic labels. Includes detailed nursing care plan guides for common nursing diagnostic labels.
Other nursing care plans related to respiratory system disorders:
- Asthma | 9 Care Plans UPDATED!
- Bronchiolitis | 7 Care Plans UPDATED!
- Bronchopulmonary Dysplasia (BPD) | 7 Care Plans UPDATED!
- Chronic Obstructive Pulmonary Disease (COPD) | 7 Care Plans UPDATED!
- Cystic Fibrosis | 6 Care Plans UPDATED!
- Hemothorax, Pneumothorax, and Pleural Effusion | 5 Care Plans UPDATED!
- Influenza (Flu) | 6 Care Plans UPDATED!
- Lung Cancer | 7 Care Plans UPDATED!
- Mechanical Ventilation & Endotracheal Intubation | 10 Care Plans UPDATED!
- Drowning (Submersion Injury) | 7 Care Plans UPDATED!
- Pneumonia | 11 Care Plans
- Pulmonary Embolism | 4 Care Plans
- Pulmonary Tuberculosis | 5 Care Plans
- Tracheostomy | 5 Care Plans
References and Sources
To further your research and reading about lung cancer, check out these sources:
- Albano, D., Feraca, M., & Nemesure, B. (2021, April). An Assessment of Distress Levels of Patients Undergoing Lung Cancer Treatment and Surveillance During the COVID-19 Pandemic. The Journal for Nurse Practitioners, 17(4), 489-491.
- American Lung Association. (2022, November 17). Find Support for Lung Cancer. American Lung Association. Retrieved December 19, 2022.
- Centers for Disease Control and Prevention. (2022, June). Perceived Exertion (Borg Rating of Perceived Exertion Scale) | Physical Activity. CDC. Retrieved December 19, 2022.
- Chen, X., Yao, J., Xin, Y., Ma, G., Yu, Y., Yang, Y., Shu, X., & Cao, H. (2022, November 29). Postoperative Pain in Patients Undergoing Cancer Surgery and Intravenous Patient-Controlled Analgesia Use: The First and Second 24 h Experiences. Pain and Therapy.
- Drareni, K., Dougkas, A., Giboreau, A., Laville, M., Souquet, P.-J., & Bensafi, M. (2019, April). Relationship between food behavior and taste and smell alterations in cancer patients undergoing chemotherapy: A structured review. Seminars in Oncology, 46(2), 160-172.
- Farrell, M. (2016). Smeltzer & Bares Textbook of Medical-surgical Nursing (M. Farrell, Ed.). Lippincott Williams & Wilkins Pty, Limited.
- Gupta, R., & Wadhwa, R. (2022, July 4). Mucolytic Medications – StatPearls – NCBI Bookshelf. NCBI. Retrieved December 16, 2022.
- Hendriksen, E., Rivera, A., Williams, E., Lee, E., Sporn, N., Cases, M. G., & Palesh, O. (2019). Manifestations of anxiety and coping strategies in patients with metastatic lung cancer and their family caregivers: a qualitative study. Psychology & Health, 34(7).
- Hinkle, J. L., & Cheever, K. H. (2018). Brunner & Suddarth’s Textbook of Medical-surgical Nursing. Wolters Kluwer.
- Hochberg, U., Elgueta, M. F., & Perez, J. (2017). Interventional Analgesic Management of Lung Cancer Pain. Frontiers in Oncology, 7(17).
- Hoy, H., Lynch, T., & Beck, M. (2019). Surgical Treatment of Lung Cancer. Critical Care Nursing, 31, 303-313.
- Keith, R. L. (2022, December). Lung Cancer – Lung and Airway Disorders – MSD Manual Consumer Version. MSD Manuals. Retrieved December 16, 2022.
- Lan, C.-C., Hsu, H.-H., Wu, C.-P., Chang, C.-Y., Peng, C.-K., & Chang, H. (2011, May 15). Lateral Position with the Remaining Lung Uppermost Improves Matching of Pulmonary Ventilation and Perfusion in Pneumonectomized Pigs. Cardiothoracic, 167(2), E55-E61.
- Liao, Y.-C., Liao, W.-Y., Sun, J.-L., Ko, J.-C., & Yu, C.-J. (2018). Psychological distress and coping strategies among women with incurable lung cancer: a qualitative study. Supportive Care in Cancer, 26, 989-996.
- Liu, C.-J., Tsai, W.-C., Chu, C.-C., Muo, C.-H., & Chung, W.-S. (2019, July 8). Is incentive spirometry beneficial for patients with lung cancer receiving video-assisted thoracic surgery? – BMC Pulmonary Medicine. BMC Pulmonary Medicine. Retrieved December 13, 2022.
- Liu, W., Pan, Y.-L., Gao, C.-X., Shang, Z., Ning, L.-J., & Liu, X. (2013, January 25). Breathing exercises improve post‑operative pulmonary function and quality of life in patients with lung cancer: A meta‑analysis. Experimental and Therapeutic Medicine, 5(4), 1194-1200.
- Makhlouf, S. M., Pini, S., Ahmed, S., & Bennett, M. I. (2019, May). Managing Pain in People with Cancer—a Systematic Review of the Attitudes and Knowledge of Professionals, Patients, Caregivers and Public. Journal of Cancer Education, 35, 214-240.
- Mancini, R. (2012, July). Chemotherapy-Induced Nausea and Vomiting: Optimizing Prevention and Management. NCBI. Retrieved December 20, 2022.
- Mazzone, P. J., Tenenbaum, A., Seeley, M., Petersen, H., Lyon, C., Han, X., & Wang, X.-F. (2016). Impact of a Lung Cancer Screening Counseling and Shared-Decision-Making Visit. Chest.
- Mele, M. C., Rinninella, E., Cintoni, M., Pulcini, G., Di Donato, A., Grassi, F., Trestini, I., Pozzo, C., Tortora, G., Gasbarrrini, A., & Bria, E. (2020). Nutritional Support in Lung Cancer Patients: The State of the Art. Clinical Lung Cancer.
- Merkle, A., & Cindass, R. (2022, October 3). Care Of A Chest Tube – StatPearls – NCBI Bookshelf. NCBI. Retrieved December 13, 2022.
- Munakomi, S. (2022, May 5). Lung Cancer – StatPearls – NCBI Bookshelf. NCBI. Retrieved December 13, 2022.
- Simmons, C. P.L., MacLeod, N., & Laird, B. J.A. (2012, October 8). Clinical Management of Pain in Advanced Lung Cancer. NCBI. Retrieved December 16, 2022.
- Sinha, V., Semien, G., & Fitzgerald, B. M. (2022, September 25). Surgical Airway Suctioning – StatPearls – NCBI Bookshelf. NCBI. Retrieved December 16, 2022.
- Swearingen, P. L. (2018). All-in-one Nursing Care Planning Resource: Medical-surgical, Pediatric, Maternity, and Psychiatric-mental Health (P. L. Swearingen & J. Wright, Eds.). Elsevier.
- Tan, W. W., & Karim, N. A. (2021, May 7). Small Cell Lung Cancer (SCLC): Practice Essentials, Pathophysiology, Etiology. Medscape Reference. Retrieved December 13, 2022.
- Tian, X., Jin, Y., Chen, H., Tang, L., & Jimenez-Herrera, M. F. (2021, March-April). Relationships among Social Support, Coping Style, Perceived Stress, and Psychological Distress in Chinese Lung Cancer Patients. Asia-Pacific Journal of Oncology Nursing, 8(2), 172-179.
- Tiep, B., Carter, R., Zachariah, F., Williams, A. C., Horak, D., Barnett, M., & Dunham, R. (2013). Oxygen for end-of-life lung cancer care: managing dyspnea and hypoxemia. Expert Review of Respiratory Medicine, 7(5).
- Wei Lo, E. Y., Sandler, G., Pang, T., & French, B. (2020, December 01). Balanced Chest Drainage Prevents Post-Pneumonectomy Pulmonary Oedema. Heart, Lung and Circulation, 29(12), 1887-1892.